This is preventive treatment for chronic migraine. A series of small injections is placed across areas of the head, neck and shoulders, and the aim is to reduce how many headache days you have in a month. It is given every twelve weeks, and it is judged over months rather than over days.
It does not act on a headache you already have. Whatever you normally take when one starts, you keep taking. The two sit alongside each other.
What it treats
Chronic migraine: headaches on many days of the month, over months, with migraine features on at least some of them. It is for people whose month is shaped around headaches rather than interrupted by one occasionally.
Frequency is the thing that decides it, which is why the first question at consultation is how many headache days you have had per month over the last three months, and how many of those were severe. A headache diary answers that precisely. A rough count is enough to start the conversation.
What a session is like
You sit upright. The injections are placed across the forehead, the temples, the back of the head, the neck and the upper shoulders, in the same pattern each time. The needle is very fine and each injection is brief.
- Session length
- About 15 minutes, and about 30 for a first visit with the assessment.
- Sensation
- A series of quick stings. The neck and shoulders are the more tender part.
- Numbing
- Not usually needed.
- Onset
- Prevention builds over 2 to 4 weeks. Some people need two treatment cycles for the full benefit.
- How long it lasts
- Through the 12-week cycle, often fading toward the end of it.
- Cadence
- Every 12 weeks, given before the benefit fades rather than after.
- Downtime
- None. Stay upright and leave the sites alone for 4 hours. Mild headache or neck and shoulder soreness for 1 to 2 days is common.
Before, during and after
This is the protocol we follow. Open any of these to read it before booking, or again the week of your appointment.
Common questions
Will it help the headache I have today?
No, and it is not meant to. This is preventive treatment. It acts on how many headache days you have in a month rather than on any single headache, and it builds over two to four weeks. Keep taking whatever you normally take when a headache starts. Nothing here replaces that.
How soon will I know whether it is working?
Prevention builds over two to four weeks after the first session. Some people need two treatment cycles, so about six months, before the full benefit is clear. That is why the diary matters. Judging it at week two, or from memory rather than a record, is judging it too early and with the wrong instrument.
Where do the injections go?
Across areas of the head, neck and shoulders, in a standard pattern: the forehead, the temples, the back of the head, the neck and the upper shoulders. The pattern is the same from session to session, which is what makes it possible to compare one cycle with the next and adjust.
Does it change how my face looks?
The forehead and temples are part of the treatment area, so some softening of lines there is a common side effect of the treatment rather than its purpose. If you want that effect, or specifically do not want it, say so at the consultation. It changes how the forehead is approached.
Why every twelve weeks?
Because that is the interval the treatment is given on. Benefit tends to fade toward the end of the cycle, and the next session is given before it fades rather than after. Keeping to the twelve weeks is a large part of whether the treatment holds.
What does the session feel like?
The needle is very fine and each injection is brief. Most people describe a series of quick stings, with the neck and shoulders the more tender part. The whole thing takes about fifteen minutes and you walk out and carry on with the day, apart from staying upright and leaving the sites alone for four hours.
What is a headache diary and how detailed does it need to be?
A date, whether you had a headache, how bad it was, and what you took. That is enough. A phone note or a paper calendar both work. The point is a record made at the time rather than a recollection at the next visit, because recollection consistently underestimates good months and overestimates bad ones.
This page is for general education and is not medical advice. It does not establish a physician-patient relationship, and it cannot account for your individual history, medications or skin. Suitability for treatment is decided at consultation following examination.